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[MRSA infections in the neonatal unit]
1Department of Pediatrics, Teikyo University School of Medicine, Ichihara Hospital.
Abstract:
MRSA infection in the neonatal unit is discussed, presenting our experience of an epidemic of TSST-1-positive strains in the Teikyo University Hospital in 1988-1989. Neonatal MRSA infections were experienced for the first time in 1982, and a few cases were treated each year from 1984 to 1987. In October 1988, MRSA-colonized and/or diseased cases increased abruptly after admission of several MRSA-positive neonates. The new strains were TSST-1-positive, coagulase type II organisms, which were multiply resistant, including gentamicin. The disease/colonization ratio was 37.0% in 108 colonized neonates. Among them, 5 cases of atypical TSS were experienced. The main clinical manifestation was an abrupt onset of shock with leukopenia. Some of the cases were afebrile and rash was hard to recognise. For the successful treatment of neonatal TSS, not only effective antibiotics but also prompt exchange transfusions were needed.
Insights
An epidemic of TSST-1-positive MRSA strains caused severe neonatal infections, including atypical toxic shock syndrome (TSS). Prompt exchange transfusions alongside antibiotics were crucial for treating these multiply resistant infections.
Area of Science:
- Neonatal infectious diseases
- Microbiology
- Epidemiology
Context:
- MRSA infections pose a significant threat in neonatal units.
- An epidemic of TSST-1-positive MRSA strains occurred at Teikyo University Hospital from 1988-1989.
- Previous MRSA cases were sporadic before the epidemic.
Purpose:
- To describe the experience and characteristics of a MRSA epidemic in a neonatal unit.
- To analyze the clinical manifestations and treatment outcomes of neonatal MRSA infections, particularly toxic shock syndrome (TSS).
Summary:
- An abrupt increase in MRSA-colonized and/or diseased neonates was observed in October 1988.
- The epidemic strains were TSST-1-positive, coagulase type II, and multiply resistant, including to gentamicin.
- The disease/colonization ratio was 37.0% among 108 neonates, with 5 cases of atypical TSS presenting with shock and leukopenia, often without fever or rash.
Impact:
- Highlights the severity of TSST-1-positive MRSA strains in neonates.
- Emphasizes the need for effective antibiotics and prompt exchange transfusions for treating neonatal TSS.
- Informs infection control strategies in neonatal intensive care units.